Root Reimplantation with Aortic Arch Replacement and Frozen Elephant Trunk in Acute Aortic Dissection

A 50-years-old woman was admitted under the diagnosis of acute type A aortic dissection (Figure 1A & 1B). An emergency operation was performed through median sternotomy and antegrade cerebral perfusion with moderated hypothermia. During the operation we found that the ascening aorta was dilated and the intimal were teared in mid ascending aorta and the dissection was extended throughout the whole aorta. The aortic root was dilated especially in the noncoronary sinus (Figure 1C) but the aortic leaflet was well preserved. We connected arterial line via 8mm graft anastomosed into the right subclavian artery through a seperated subclavian incision, and venous cannulation was performed with a single venous cannule into the right atrium. During establishing the moderate hypothermia, the ascending aorta was clamped, and cardia arrest was induced with retrograde cardioplegic infusion. The aortic root was dissected down to the level of the aortic anulus and the both coronary orifice were deteched from the sinus and the aortic anulus was trimed as a bottom shape after removal of all sinus wall.